office representative registration · representative details:director/senior officer declaration...
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![Page 1: OFFICE REPRESENTATIVE REGISTRATION · REPRESENTATIVE DETAILS:Director/Senior Officer Declaration Signatory Date(Signature) collect and deliver documents on behalf of this company](https://reader036.vdocuments.mx/reader036/viewer/2022071223/60811e8146f87f5b6275ac41/html5/thumbnails/1.jpg)
OFFICE REPRESENTATIVE REGISTRATIONBritish Virgin Islands Financial Services Commission
Company:
(Signature)
User Signature:
Last Name: First Name:
Job Title: Email Address:
If this is a temporary appointment, please fill in the effective dates:
From:
(DD/MM/YY)
To:
(DD/MM/YY)
Address 2:
Address 1:
Telephone:Email:
REPRESENTATIVE DETAILS:
Director/Senior Officer Declaration
(DD/MM/YY)
Signatory Date
(Signature)
(PRINT NAME)
By signing this Declaration, I indicate that the person named in this registration form is authorised to collect and deliver documents on behalf of this company.
copy of a Government issued photo ID is attached
ORF01 (03/2017)
Mobile:
(DD/MM/YY)
Please complete and provide a copy of the representative's government issued photo id